Provider Demographics
NPI:1558568410
Name:MENINI, PERRY J (DO)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:J
Last Name:MENINI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 DELNOR DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4220
Mailing Address - Country:US
Mailing Address - Phone:630-232-0610
Mailing Address - Fax:630-232-0675
Practice Address - Street 1:351 DELNOR DR
Practice Address - Street 2:SUITE 410
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4220
Practice Address - Country:US
Practice Address - Phone:630-232-0610
Practice Address - Fax:630-232-0675
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036107456207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036107456Medicaid
ILCA4748OtherRAILROAD MEDICARE PTAN (GROUP)
IL206147OtherMEDICARE PTAN (GROUP)
IL206147089OtherMEDICARE PTAN (INDIVIDUAL)
ILP01090802OtherRAILROAD MEDICARE PTAN (INDIVIDUAL)
IL036107456Medicaid